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Submitted by Saul Walker on
Partricio, I think in many countries a real focus on getting an HMIS system working is key to improving performance, but is often not an immediate priority. Various vertical programmes and funders bolt together various indicator sets that often overlap, or which cannot usefully be cross-referenced. And yet availability and usability of routine (nearer real-time) information are fundamental to actively managing a system, making allocation decisions, monitoring performance and supporting accountability both upwards and downwards. Whether or not to go straight in with an electronic records management system at facility level will depend on context, but a first step of getting the information architecture in a system right is essential (and will make digitisation far simplier when rolled out). A well thought through architecture can minimise the number of indicators that need to be collected, and support more productive multi-variate analysis. mHealth solutions are begining to make digitisation closer to point of care a possibility. There are also a number of open source initiatives being developed for mHMIS platforms. Togteher these present fantasitic opporunties (although inter-operability of systems will be essential if we are not to end up with electronic spaghetti). Crucially, digitisation makes data usable; verification algorithms can reduce manual data cleaning considerably; dashboard approaches can make data accessible; rooms of discarded paper slowly rotting can be dispensed with. And most importantly, if data is used to inform decisions that then impact on service delivery units (feedback) then the motivations to provide data change (why bother providing information that's not going to be used?). Overhalling an information system is can be daunting, and is often perpetually deferred. As information is often second only in political significance to money, reforms are always contencious. And this is not just within governments. Donors are increasingly trying to aggregate results from across their different country programmes to report back to domestic constituencies. They have their own views on what to record. However, the ongoing inefficiency of current information systems, both in terms of their own running costs and in their lack of fitness for purpose for effective management, is enormous. Unfortunately, health systems are not like Luke Skywalker (who could fight his enemies by shutting his eyes and feeling the Force), they need to have their eyes open (i.e. have data) to see what's going on.